A mixed methods approach to evaluating the Role of individual differences: Impact on fruit and vegetable intake outcomes in NOURISH-T+ parents of pediatric cancer survivors

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Project Summary Interventions successfully addressing healthy lifestyle behavior (e.g., healthy eating, physical activity) in pediatric cancer survivors (PCS) are urgently needed as approximately 40% to 50% of PCS have overweight/obesity. Modifiable behaviors, such as unhealthy dietary intake and sedentary behavior are key to post-treatment weight gain among PCS. Improving eating behaviors and physical activity in PCS decreases the risk of negative late effects and chronic illness. The parent grant to this application, R01CA240319, is the first large scale multi-site, randomized controlled clinical trial of an intervention (NOURISH-T+) that targets obesity in a diverse group of English and Spanish speaking PCS and their parents. The intervention program, NOURISH-T+, tested in the parent grant is an efficacy trial and does not investigate the variability in intervention outcomes that has been described in the scientific literature as important in increasing understanding of goal attainment and behavior change. The potential for intervention outcome variability in NOURISH-T+ raises the importance of examining individual differences that might explain intervention efficacy, maximize intervention impact, and inform future tailoring of this approach, consistent with the trend to personalized medicine. Relatively little is known about what key factors explain individual variability in behavior change outcomes. There are major gaps in our understanding of the mechanistic role of motivation and other individual differences. The proposed project addresses this knowledge gap by exploring, through a mixed-methods design, the role of individual differences on fruit and vegetable (F/V) intake, a standard index related to behavioral change.  Aim 1: Examine the variability in primary F/V intake outcomes at 3-months post-intervention. o Aim 1a: Identify F/V intake extreme observations (i.e., highest adherence to F/V guidelines vs. lowest adherence) to guide the selection of participants to interview. o Aim 1b: Examine the relation between potential individual difference variables and F/V intake to inform the construction of the semi-structured interview guide.  Aim 2: Describe parents' perceptions of potential individual difference variables most important to them in eliciting behavior change via semi-structured interviews. During this diversity supplement, I will gain further experience that will enable me to take my cancer research career to the next level. My long-term career goal is to become an independent cancer research clinician- scientist focused on the design and implementation of culturally adapted health behavior change interventions designed to improve lifestyle, quality of life, and survivorship in children, adolescents and young adults, and their families. My short-term career goals include completing my Ph.D. studies, gaining the skills necessary to compete for a top post-doctoral fellowship in cancer control, and writing a successful F32 grant.